Tian Yuanhu, Yang Guangyun, Liu Bo, Xia Hongtian, Wang Jing, Zhang Aiqun, Huang Zhiqiang, Dong Jiahong
Institute of Hepatobiliary Surgery, Hospital of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Institute of Hepatobiliary Surgery, Hospital of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China. Email:
Zhonghua Wai Ke Za Zhi. 2015 Feb;53(2):135-9.
To analyze the surgical management of incidental gallbladder cancer (IGBC) discovered during or after laparoscopic cholecystectomy (LC) and to evaluate the associated factors of survival.
A retrospective analysis of patients with IGBC between January 2002 and December 2013 was performed. A total of 10 080 consecutive patients underwent LC operation for presumed gallbladder benign disease in Chinese People's Liberation Army General hospital. And among them, 83 patients were histologically diagnosed as IGBC. Data covering clinical characteristics, surgery records, local pathological stage, histological features and factors for long term survival were reviewed. The survival analysis was performed using Kaplan-Meier method, and the results were examined using the log-rank test.For multivariate statistical analyses of prognostic factors, a Cox proportional hazards model was carried out.
A total of 83 patients with IGBC:68.7% females (57/83), median age of 61 years (range 34-83 years). There were 47 cases accepted the initial simple LC, 18 cases converted to open extended radical cholecystectomy, 16 cases with radical second resection, and 2 cases with re-laparotomy; the 5-year survival rates for each group were 89.4%, 38.9%, 87.5%, and 0, respectively. The 5-year survival rates in T1a, T1b, T2, and T3 stage patients were 95.7% (22/23), 90.0% (18/20), 75.0% (15/20), and 40.0% (8/20), respectively. Univariate analysis for prognostic factors associated with cancer-specific death showed that depth of invasion, lymph-node status, vascular or neural invasion, tumor differentiation, extent of resection, bile spillage during prior LC and type of surgery were statistically significant.In multivariate analysis, depth of invasion, extent of resection and bile spillage were the most important prognostic factors related to both cancer-specific mortality and disease relapse (P < 0.05).
Simple LC is appropriate for T1a patients with clear margin and unbroken gallbladder. An extended radical resection in patients with T1b or more is highly recommended, and provided as a potentially curative R0 resection only if it is necessary.
分析在腹腔镜胆囊切除术（LC）期间或之后发现的意外胆囊癌（IGBC）的手术治疗方法，并评估其生存相关因素。
对2002年1月至2013年12月期间患有IGBC的患者进行回顾性分析。在中国人民解放军总医院，共有10080例连续患者因推测为胆囊良性疾病接受了LC手术。其中，83例经组织学诊断为IGBC。回顾了涵盖临床特征、手术记录、局部病理分期、组织学特征和长期生存因素的数据。采用Kaplan-Meier方法进行生存分析，并使用对数秩检验检查结果。对于预后因素的多变量统计分析，进行了Cox比例风险模型分析。
共有83例IGBC患者：女性占68.7%（57/83），中位年龄61岁（范围34 - 83岁）。47例最初接受单纯LC，18例转为开腹扩大根治性胆囊切除术，16例接受根治性二次切除术，2例再次开腹手术；每组的5年生存率分别为89.4%、38.9%、87.5%和0。T1a、T1b、T2和T3期患者的5年生存率分别为95.7%（22/23）、90.0%（18/20）、75.0%（15/20）和40.0%（8/20）。与癌症特异性死亡相关的预后因素单变量分析显示，浸润深度、淋巴结状态、血管或神经浸润、肿瘤分化、切除范围、先前LC期间的胆汁溢出和手术类型具有统计学意义。多变量分析中，浸润深度、切除范围和胆汁溢出是与癌症特异性死亡率和疾病复发相关的最重要预后因素（P < 0.05）。
单纯LC适用于切缘清晰且胆囊完整的T1a患者。强烈建议对T1b及以上患者进行扩大根治性切除，仅在必要时作为潜在的治愈性R0切除提供。
